Exercise, Mental Stress, Risk of a Heart Attack and Carnitine: Special Note to Diabetics

Though discovered awhile back, few are aware that when the oxygen supply to your heart is dangerously low due to coronary artery blockage- the step before both a fatal and non-fatal heart attack – oftentimes you don’t know it! When I trained as a doctor we were taught that when the heart’s blood supply was significantly reduced a patient would experience chest pain or angina pectoris as a warning sign which told patients to stop what they were doing. Not so! Many times you feel nothing at all so you keep doing what you’re doing. This absence of warning signs is called silent myocardial ischemia. We were also taught that most episodes of ischemia were due to physical stress while, for example, shoveling snow or even during minor chores. Also, not so! With modern cardiovascular technology we found that mental stress is also a very common cause of silent ischemia. What really caught my eye and causes me concern is that telephone conversations not infrequently cause silent ischemia. I wonder if there’s now a silent ischemia epidemic going on under our eyes due to the exploding use of cellphones. In fact, we should all wonder!

Many Americans, from the young to the oldtimers, are now heavily involved in ongoing exercise regimens be it on a treadmill, lifting weights, strenuous sports and jogging among others. Also, it is no secret that life today is increasingly emotionally stressful, particularly due to familial turmoil and economic worries. When silent ischemia occurs it can lead to the destruction of only a small amount of myocardium or heart cells. When, however, the ischemic events periodically continue, more myocardium is destroyed at each episode, and there comes time when there is insufficient myocardium left to function normally after an ischemic attack resulting in either a non-fatal or fatal heart attack.

It is estimated that approximately 3 million Americans experience silent ischemia, and about 450,000 American drop dead from heart attacks annually many without warning to give them enough time to get to the emergency room. Recently, in my hometown my dentist, in his early 50’s, dropped dead while on the treadmill and in the next town a woman undergoing stressful divorce followed suit. As an aside issue, I’m particularly concerned about the alarming rising level of emotional stress among women. Recently, I was discussing my concerns with a divorced woman and family friend. She’s in her late forties and has three young children.  After taking a sip of wine she laid her head back on the chair headrest , signed and said, “Doc, you don’t know how difficult it is to wake up alone in the morning with my three kids with the weight of responsibility of my family on my shoulders. Sometimes I feel as if I can’t handle it.” During or conversation her cell phone rang a number of times.

What then is the solution? I don’t practice medicine on this website but there is one principle of medicine that even the most conservative doctors would agree upon. It’s prevention. With respect to the heart, this may mean that you must have a sufficient blood level of a particular substance(s), like a reservoir, available to enter the heart cells to reduce the damage of silent ischemia whenever it occurs. In my previous post I spoke about carnitine as nature’s natural protector against myocardial ischemia – silent or not- but normal blood levels are not sufficient to protect the heart and supplementation is needed. I understand some serious exercise folks take carnitine supplementation to increase muscular performance. But they are unaware that carnitine, if you take enough, may also protect your heart against ischemia, silent or not. (Silent ischemia is common in patients who already have had a heart attack). Regarding mental stress and silent ischemia, for some strange reason this has not received the critical national attention that it deserves. There are traditional well -trained doctors who also recommend alternative medical therapies and surely know about carnitine. It you’re interested, turned to them for advice.

And a final reminder: Let’s not forget that diabetics are more susceptible to myocardial and other organ ischemia such as the kidney and legs. Also, that magnesium supplementation in diabetics is important (see previous post) and can safely be given along with carnitine.

One Response to “Exercise, Mental Stress, Risk of a Heart Attack and Carnitine: Special Note to Diabetics”

  1. Dr. DeFelice,
    I love your books and writing. Have you seen this article?

    http://online.wsj.com/article/SB10001424127887324050304578408702646200088.html

    Sincerely,
    Mike Morano